– Karobi Das, Jogindra Vati, Indarjit Walia

Abstract : The objective of the present study was (a) to assess the frequency and degree of physical and psychological distress among the students and (b) to compare the distress between the two groups. A purposive sample of 95 students were selected from National Institute of Nursing Education, PGIMER, Chandigarh which comprised of 44 students of B.Sc. Nursing, Interns (4th year) who joined the course after plus two (medical) and 51 students of B.Sc. Nursing (Post-Basic) who had minimum 2 years clinical work experience. The Cornell Medical Index (CMI) health questionnaire on physical and psychological distress was administered. The findings of the study revealed a relative degree of physical and psychological distress among the students. However majority of them had severe/moderate psychological distress which indicated the need to identify the factors leading to these distresses and sensitive handling of their problems.

Key Words :

Physical and psychological distress, nursing students, health questionnaire

Correspondence at :

Karobi Das, Lecturer

National Institute of Nursing Education, PGIMER, Chandigarh, India.


The soldier who sustains a wound in battle, the player exerting himself to the full in the match, the mother worrying about her children’s health, or the gambler watching the races are all under stress. This mysterious thing that affects everyone’s life, touches the very essence of life, health and disease.

The present era is described as an age of stress. Stress related problems and distresses are increasing all over the world. The very nature of contemporary society, the rapidity of changes contribute to the strains that are associated with or derived from stressful events.

The word stress is used to describe the specific agent responsible for the disturbance of equilibrium in the subject as well as to describe the state of organism or object which is subjected to stress e.g.: stress fractures in bones, airplane bodies etc. The word stress should be used to designate the sum of all the non-specific effects of various factors acting on the body whereas these agents should be referred to as stressors when we refer to their ability to produce stress1. Prolonged stress can be a contributory factor to bring about physical as well as psychological distress in the form of many ailments like asthma, headaches, backaches, gastric-ulcer, heart diseases and above all many mental disorders.

Stress has become a common problem for the nurses; the most dedicated nurses are more likely to succumb to severe stress. Nurses who cannot cope with rigors of their work argue with their colleagues, absent themselves from work, fall ill or leave the profession. This is bad for the patients and a sad commentary for the health services.

Nurses have been listed among a group of health professionals who may be regarded as ‘the casualties of caring’ as there is a growing amount of evidence to suggest that nursing profession can indeed be a stressful one2. A survey in the western countries like U.S.A. and U.K. have considered “nursing among those professional groups who have the highest rates of suicide and nurses also top the list of psychiatric outpatient referral”3.

Although the responsibility of nurses has changed radically, both the public, and other health care providers continue to hold a traditional stereotype image of the nurse, as a dependent assistant to the physicians without authority and power. The nurses contribution to the management of patient, is thus never officially recognized.

Nursing as a women’s profession; by its very name is a nurturing process Cleland (1971) states that “there is no doubt in my mind that our most fundamental problem in nursing is that we are the members of a women’s occupation in a male dominated culture4. Stress has been found to be more in the nursing profession5. The stress of the nursing profession along with their consequences are not limited to students during training but span over the nurses’ entire career. Stress develops from the point of entry and builds on to later life experiences in the profession. It was found that the trained nurses shared a common perception with students of what was stressful in the wards6.

A great deal of stress is encountered by the nursing students in the course of adjusting to a rigorous course of clinical practice. The reality of nursing education is often far different from a prospective students’ image of it. Studies of nursing students report that clinical experience, examinations, home work, poor social suppor t and low levels of concentration are the stressful experiences7,8,9. The stress of health care education has therefore been noted in the literature as a serious issue for students in the field of nursing10.


The objectives of the study were to:

  • Assess the frequency and degree of physical and psychological distress among the students and
  • To compare the distress between two

Materials and Methods

A purposive sample of 95 students were selected from College of Nursing PGIMER, Chandigarh upgraded as National Institute of Nursing Education, PGIMER, Chandigarh. One group comprised of 44 students of B.Sc. Nursing (4th year) who joined the course after plus two (medical). Presently they were undergoing internship in the hospital. The second group comprised of 51 students who had done either a diploma or degree in nursing and also had two years of clinical work experience.

The Cornell Medical Index (CMI)11 health questionnaire comprising of 195 questions related to physical (144 questions) and psychological (51 questions) distress was administered. There are two formats of the questionnaire. One is for the ‘women’ and another for ‘men’. Both the formats are identical except for the change in the questions pertaining to genito-urinary system. For the present study CMI for ‘women’ was used.

The questions are worded in a simple manner which can be understood by persons with reading knowledge of English. At the end of each question there is a ‘yes’ and ‘no’ for answering the question. The respondent is instructed to answer the question by encircling the appropriate response. In every instance ‘yes’ answer indicates that the respondent claims to have the symptom.

The CMI is divided in two sections:

  • A – L section includes items on physical There are 144 items in this section.
  • M – R section includes items on psychological This section has 51 items.

A serious disorder is to be suspected when more than 25 items are answered as ‘yes’. If the affirmative responses are more than 15 in the A-L section the individual has physical distress in the medical/physical areas. More than 3 such affirmations on the M-R section of the questionnaire are suggestive of a psychological distress.


A sample of 95 nursing students were taken up for the study. Mean age of group-I was 21 years (+.8) while group-II was ten years older (31.8 years, +6.5) than group-I students. All the students of group-I were unmarried, had completed plus two and entered the nursing degree course and presently were engaged in full-fledged nursing duties as this was their period of internship. The second group which was older comprised of 23 unmarried and 28 in service married nurses who had either done their diploma or degree in nursing and were pursuing higher studies.

Table-1 shows the mean scores of distress experienced by the two groups. The table shows that group-II had higher mean scores in physical, psychological and total distress as compared to group-I, though this difference was not statistically significant.

Table – I : Mean scores of distress between the two groups

CMI Group-I n = 44 Group-II n = 51  


Physical distress 10.4

+ 7.1





Psychological distress 5.02 6.5 1.64
Total distress 16.0






df=93 p<.05

Table-2 shows the distribution of the two groups according to cut off points in distress scores. According to the table 82% of the sample in group-I did not experience physical distress as compared to 67% of group-II. On the other hand high physical distress (scores above 15) was experienced by 18% of group-I and 33% of group-II.

Table – 2 : Distribution of the two groups according to cut off points in distress scores

CMI Cut off Points Group-I n = 44 Group-II n = 51
    Within Average High distress Within average High distress
Physical distress 15 36(82) 8(18) 34(67) 17(33)
Psychological 5 23(52) 21(48) 19(37) 32(63)
Total distress 20 33(75) 11(25) 28(55) 23(45)

As regards psychological distress in group-I, 52% did not have any psychological distress as compared to 37% of group-II. Forty eight percentage of group-I experienced psychological distress as against 63% of group-II.

The comparison of scores on total distress shows that 25% of group-I experienced high total distress as compared to 45% of group-II. On the whole group-II had higher percentage of the sample experiencing higher degrees of physical, psychological and total distress.


Nursing students differ in no way from other students as they experience and cope with stress and strain. A study conducted on the Indian women, revealed that among all the professionals, stress was found to be more among the nurses5. Nursing students are no exception to the experience of stress, because a student nurse of today will be a staff nurse of tomorrow. She actually experiences more stress as compared to the ordinary student.

One of the reasons perhaps of experiencing more stress by the nursing students is that the majority of students are of younger & middle aged group, which in itself is a period characterized by heightened stress and strain. Women adopting this vocation have to perform dual role i.e. role of an employee meeting the demands of the job and caring for family members. These two roles create many worries, distress, both physical and mental.

B.Sc. Nursing (Post-Basic) students who were the middle aged group had greater physical and psychological distress as compared to students of other group, who were younger though this difference was not statistically significant. This also revealed that the subjects who were already in service had more physical and psychological distress as compared to the subjects who had not yet joined the job.

It was seen that experienced subjects had more physical distress (33%) compared to subjects who were without any work experience. If we compare their scores on psychological distress the experienced group had higher distress (63%) as compared to the other group (45%). Total distress scores was also low in the younger and inexperienced subjects (25%) as compared to older (45%) and experienced group subjects. As a career transition which was most probably triggering event for personal life instability the nurses who had resumed their studies after 2 to 3 years of service in the wards were having high distress scores in physical and psychological areas. The younger group were also vulnerable to stress exhibited distress scores though less as compared to the older (work experienced) group.

Inspite of the limitations of the study, as it was based only on Cornell Medical Index, which does not explore the factors that can lead to distress, it is concluded that there is physical and psychological distress among the student nurses. Some of the students also had obtained a high distress score. Hence there is a need to identify the factors leading to these distresses and sensitive handling of their problems.


  1. Selye The Stress of Life. New York: McGraw Hills Book Co., 1965.
  2. Bailey Look after yourself, Nursing Times 1985; 8, 37: 35-37.
  3. Gillespie C, Gillespie Reading the danger sign. Nursing Times 1986; 82, 31: 24-27.
  4. Cleland Sex discrimination: Nursing’s most pervasive problem. American Journal of Nursing 1971; 71, 1; 542-544.
  5. Trygstage LN. Stress and coping in psychiatric Journal of Psycho-social Nursing 1986; 23-27.
  6. Price Moving wards – How do student nurses cope. Nursing Times 1983; 81, 9: 32-38.
  7. Gulabani An exploratory study of the nature and intensity of the problems encountered by the present B.Sc. (Hons.) nursing students. Unpublished dissertation 1965; R.A.K. College, New Delhi.
  8. Hazra A study of the adjustment problems of 1st year students of the general nursing midwifery course. Calcutta, Unpublished dissertation 1970; R.A.K. College, New Delhi.
  9. erghese Study of the relationship of achievement with personality characteristics and problems faced by students. Unpublished dissertation 1974; R.A.K. College, New Delhi.
  10. Donnelly JA. Stress and adolescent nurse, Australian Nurses Journal 1981; 11:37-
  11. Wig NN,   Pershad  D,   Verma Abridged Manual for Cornell Medical Index Health Questionnaire. Chandigarh: PGIMER, Department of Psychiatry, 1983.
  12. Walia IJ. et al. Health status of nurses and Yoga: Subjects with and without health problems, Part-II, Nursing Journal of India 1989; 80, 10; 256-258.